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Sullivan MD, Wilson L, Amick M, Miller-Matero LR, Chrusciel T, Salas J, Zabel C, Lustman PJ, Ahmedani B, Carpenter RW, Scherrer JF. Social support and the association between post-traumatic stress disorder and risk for long-term prescription opioid use. Pain 2024:00006396-990000000-00617. [PMID: 38833573 DOI: 10.1097/j.pain.0000000000003286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/15/2024] [Indexed: 06/06/2024]
Abstract
ABSTRACT Post-traumatic stress disorder (PTSD) is common in patients with chronic pain, adversely affects chronic pain outcomes, and is associated with opioid use and adverse opioid outcomes. Social support is a robust predictor of PTSD incidence and course as well as chronic pain outcome. We determined whether the association between PTSD and persistent opioid use was modified by emotional support in a cohort of patients receiving opioids for noncancer pain. Eligible participants were ≥18 years and had completed a new period of prescription opioid use lasting 30 to 90 days. Bivariate associations between cohort characteristics and each key variable was assessed using χ2 tests for categorical variables and t-tests for continuous variables. Interaction between PTSD and emotional support was assessed by a priori stratification on low vs high emotional support. Participants (n = 808) were 53.6 (SD ± 11.6) years of age, 69.8% female, 69.6% White, and 26.4% African American. Overall, 17.2% had probable PTSD. High emotional support was significantly (P < 0.0001) more common among those without probable PTSD. Prescription opioid use at 6-month follow-up was significantly (P = 0.0368) more common among patients with vs without probable PTSD. In fully adjusted models, PTSD was no longer associated with opioid use at 6-month follow-up among participants with high emotional support. Among those with lower emotional support, PTSD was significantly associated with opioid use at 6-month follow-up in unadjusted (odds ratio = 2.40; 95% confidence interval: 1.24-4.64) and adjusted models (odds ratio = 2.39; 95% confidence interval: 1.14-4.99). Results point to the hypothesis that improvement of emotional support in vulnerable patients with chronic pain and PTSD may help reduce sustained opioid use.
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Affiliation(s)
- Mark D Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, United States
| | - Lauren Wilson
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Matthew Amick
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Lisa R Miller-Matero
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI, United States
| | - Timothy Chrusciel
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, United States
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Celeste Zabel
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI, United States
| | - Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Brian Ahmedani
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI, United States
| | - Ryan W Carpenter
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, United States
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, United States
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, United States
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Turcotte JJ, Brennan JC, Johnson AH, King PJ, MacDonald JH. Managing an epidemic within a pandemic: orthopedic opioid prescribing trends during COVID-19. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05329-y. [PMID: 38661999 DOI: 10.1007/s00402-024-05329-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION In response to the opioid epidemic, a multitude of policy and clinical-guideline based interventions were launched to combat physician overprescribing. However, the sudden rise of the Covid-19 pandemic disrupted all aspects of healthcare delivery. The purpose of this study was to evaluate how opioid prescribing patterns changed during the Covid-19 pandemic within a large multispecialty orthopedic practice. MATERIALS AND METHODS A retrospective review of 1,048,559 patient encounters from January 1, 2015 to December 31, 2022 at a single orthopedic practice was performed. Primary outcomes were the percent of encounters with opioids prescribed and total morphine milligram equivalents (MMEs) per opioid prescription. Differences in outcomes were assessed by calendar year. Encounters were then divided into two groups: pre-Covid (1/1/2019-2/29/2020) and Covid (3/1/2020-12/31/2022). Univariate analyses were used to evaluate differences in diagnoses and outcomes between periods. Multivariate analysis was performed to assess changes in outcomes during Covid after controlling for differences in diagnoses. Statistical significance was assessed at p < 0.05. RESULTS The percentage of encounters with opioids prescribed decreased from a high of 4.0% in 2015 to a low of 1.6% in 2021 and 2022 (p < 0.001). MMEs per prescription decreased from 283.6 ± 213.2 in 2015 to a low of 138.6 ± 100.4 in 2019 (p < 0.001). After adjusting for diagnoses, no significant differences in either opioid prescribing rates (post-COVID OR = 0.997, p = 0.893) or MMEs (post-COVID β = 2.726, p = 0.206) were observed between the pre- and post-COVID periods. CONCLUSION During the Covid-19 pandemic opioid prescribing levels remained below historical averages. While continued efforts are needed to minimize opioid overprescribing, it appears that the significant progress made toward this goal was not lost during the pandemic era.
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Affiliation(s)
- Justin J Turcotte
- Luminis Health Anne Arundel Medical Center, Department of Orthopedics, 2000 Medical Parkway, Suite 503, Annapolis, MD, 21401, USA.
| | - Jane C Brennan
- Luminis Health Anne Arundel Medical Center, Department of Orthopedics, 2000 Medical Parkway, Suite 503, Annapolis, MD, 21401, USA
| | - Andrea H Johnson
- Luminis Health Anne Arundel Medical Center, Department of Orthopedics, 2000 Medical Parkway, Suite 503, Annapolis, MD, 21401, USA
| | - Paul J King
- Luminis Health Anne Arundel Medical Center, Department of Orthopedics, 2000 Medical Parkway, Suite 503, Annapolis, MD, 21401, USA
| | - James H MacDonald
- Luminis Health Anne Arundel Medical Center, Department of Orthopedics, 2000 Medical Parkway, Suite 503, Annapolis, MD, 21401, USA
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Goldman JG, Merkitch D, Brewington D, Peirce H, Rho M, Jayabalan P, Curran J, Brennan K. Patient experiences receiving rehabilitation care via telehealth: Identifying opportunities for remote care. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1049554. [PMID: 36817717 PMCID: PMC9932031 DOI: 10.3389/fresc.2023.1049554] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023]
Abstract
Use of telehealth has grown substantially in recent times due to the COVID-19 pandemic. Remote care services may greatly benefit patients with disabilities; chronic conditions; and neurological, musculoskeletal, and pain disorders, thereby allowing continuity of rehabilitation care, reducing barriers such as transportation, and minimizing COVID-19 exposure. In March 2020, our rehabilitation hospital, Shirley Ryan AbilityLab, launched a HIPAA-compliant telemedicine program for outpatient and day rehabilitation clinics and telerehabilitation therapy programs. The objective of this study was to examine patients' experiences and satisfaction with telemedicine in the rehabilitation physician practice, including novel virtual multidisciplinary evaluations. The present study examines survey data collected from 157 patients receiving telemedicine services at Shirley Ryan AbilityLab from December 2020-August 2021. Respondents were 61.8% female, predominantly White (82.2%) with ages ranging across the lifespan (69.4% over age 50 years). Diagnostic categories of the respondents included: musculoskeletal conditions 28%, chronic pain 22.3%, localized pain 10.2%, neurological conditions 26.8%, and Parkinson's and movement disorders 12.7%. Survey responses indicate that the telemedicine experiences were positive and well received. The majority of participants found these services easy to use, effective, and safe, and were overall satisfied with the attention and care they received from the providers-even for those who had not previously used telehealth. Respondents identified a variety of benefits, including alleviating financial and travel-related burdens. There were no significant differences in telehealth experiences or satisfaction across the different clinical diagnostic groups. Respondents viewed the integrated physician and rehabilitation therapist telehealth multidisciplinary model favorably, citing positive feedback regarding receiving multiple perspectives and recommendations, feeling like an integrated member of their healthcare team, and having a comprehensive, holistic team approach along with effective communication. These findings support that telemedicine can provide an effective care model in physiatry (physical medicine and rehabilitation) clinics, across different neurological, musculoskeletal, and pain conditions and in multidisciplinary team care settings. The insights provided by the present study expand our understanding of patient experiences with remote care frameworks for rehabilitation care, while controlling for institutional variation, and ultimately will help provide guidance regarding longer term integration of telemedicine in physiatry and multidisciplinary care models.
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Affiliation(s)
- Jennifer G. Goldman
- Parkinson's Disease and Movement Disorders, Shirley Ryan AbilityLab, Chicago, IL, United States,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States,Correspondence: Jennifer G. Goldman
| | - Douglas Merkitch
- Parkinson's Disease and Movement Disorders, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - David Brewington
- Information Systems, Enterprise Data Warehouse, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Hannah Peirce
- Parkinson's Disease and Movement Disorders, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Monica Rho
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Prakash Jayabalan
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jessica Curran
- Outpatient Physical Therapy, Shirley Ryan AbilityLab, Chicago, IL, United States
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Morgenroth DC, Knowlton T, Apkon S, Blauwet CA, Burns AS, Córdova Vallejos C, Frontera W, Hearn SL, Jayabalan P, Lim PA, Moroz A, Perret D, Powell D, Puderbaugh M, Rivers E, Sowa G, Verduzco-Gutierrez M, Celnik PA. Challenges and Opportunities in Academic Physiatry: An Environmental Scan. Am J Phys Med Rehabil 2023; 102:159-165. [PMID: 36634238 PMCID: PMC10233907 DOI: 10.1097/phm.0000000000002127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT Environmental scans determine trends in an organization's or field's internal and external environment. The results can help shape goals, inform strategic decision making, and direct future actions. The Association of Academic Physiatrists convened a strategic planning group in 2020, composed of physiatrists representing a diversity of professional roles, career stages, race and ethnicity, gender, disability status, and geographic areas of practice. This strategic planning group performed an environmental scan to assess the forces, trends, challenges, and opportunities affecting both the Association of Academic Physiatrists and the entire field of academic physiatry (also known as physical medicine and rehabilitation, physical and rehabilitation medicine, and rehabilitation medicine). This article presents aspects of the environmental scan thought to be most pertinent to the field of academic physiatry organized within the following five themes: (1) Macro/Societal Trends, (2) Technological Advancements, (3) Diversity and Global Outreach, (4) Economy, and (5) Education/Learning Environment. The challenges and opportunities presented here can provide a roadmap for the field to thrive within the complex and evolving healthcare systems in the United States and globally.
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Affiliation(s)
- David C. Morgenroth
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, WA, USA
| | | | - Susan Apkon
- Department of PM&R, Children’s Hospital Colorado/University of Colorado, Aurora, CO, USA
| | - Cheri A. Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston MA, USA
| | - Anthony S. Burns
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cecilia Córdova Vallejos
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Walter Frontera
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico, USA
| | - Sandra L. Hearn
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Prakash Jayabalan
- Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Peter A. Lim
- Physical Medicine and Rehabilitation Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Alex Moroz
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Danielle Perret
- University of California, Irvine, Department of Physical Medicine and Rehabilitation, Orange, CA, USA
| | - Danielle Powell
- University of Alabama Heersink School of Medicine, Department of Physical Medicine and Rehabilitation, Birmingham, AL, USA
| | - Matt Puderbaugh
- Department of Physical Medicine and Rehabilitation, Hennepin Healthcare, Minneapolis, MN, USA
| | - Evan Rivers
- Physical Medicine and Rehabilitation Service, Tennessee Valley Healthcare System, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical System, Nashville, TN, USA
| | - Gwendolyn Sowa
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- UPMC Rehabilitation Institute, Pittsburgh, PA, USA
| | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Pablo A. Celnik
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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